Pancreas

Question 1

Blood supply of the Pancreas ?

Answer 1

Supplied by branches from the Coeliac trunk artery and superior mesenteric artery.

0 Splenic a. - gives off pancreatic branches. ( apart from head )

0 Pancreas head supplied by superior pancreaticoduodenal a. - branch of Gastroduodenal a. ( branch of coeliac ——> common hepatic ——–> gastroduodenal + hepatic proper. )
and by inferior pancreaticoduodenal - branch of superior mesenteric vein.

Question 2

Venous drainage of pancreas ?

Answer 2

0 Head drains into Superior mesenteric branches of Hepatic portal vein.

0 Rest of pancreas drained by pancreatic veins -branches of Splenic vein.

Question 3

Anatomical position of Pancreas and parts ?

Answer 3

Anatomical position - L1 - Transpyloric plane.

epigastrium + left hydrochondrium.

Retroperitoneal (expect for tail )

Parts 
   0 Urnicate process
   0 Head 
   0 Neck
   0 Body 
   0 Tail

Question 4

Anatomical position of Pancreas and parts &?

Answer 4

Anatomical position - L1 - Transpyloric plane.

epigastrium + left hydrochondrium.

Retroperitoneal (expect for tail )

• behind tail - left kidney + spleen

head - sits in curve of duodenum

Stomach -anterior and superior to pancreas

ANATOMICAL RELATIONSHIP TO VASCULATURE 
  0 Pancreas sits 
     in 
     descending 
     aorta and IVC
   0 SMV , SMA anterior to urcinate process then goes underneath neck . 

• ( Superior mesenteric a. syndrome - duodenum compressed against SMA and abdominal A. ( the SMA surrounded by mesenteric fat for protection - when malnourished i.e. . anorexia , cachexia - you lose this fat - duodenal becomes compressed - symptoms of bowel obstruction

Can also cause left renal vein obstruction as renal vein goes under SMA —-> Kidney injury and left sided variocele )

Parts 
   0 Urnicate process
   0 Head 
   0 Neck
   0 Body 
   0 Tail

Question 5

What happens when food enter small intestine ?

Answer 5

stored Bile secreted from Gallbladder (stimulated) released into small intestine

Pancreas stimulated to release digestive juices ( contains digestive enzymes ) form acinar cells into main pancreatic duct ——–> duodenum

Question 6

Function of Pancreas

Answer 6

98 % of cells -Exocrine - produce digestive enzymes

2 % - Endocrine - produce hormones - Glucagon , Insulin ( found in clusters - islets of Langerhans)

Question 7

Function of S cells and I cells of small intestine ?

Answer 7

S cells - Acidic content stimulates them to produce secretin
  0 function - 
   1.   reduce 
         bile from 
         gallbladder
   2.  reduce 
        secretion 
        from liver 
        and gall 
        bladder 
   3. reduces gut 
       motility and 
       activity 
    4. Signals 
        ductile cells 
        (of main 
        pancreatic 
        duct ) to 
        secrete bi 
        carbonate - 
        neutralise 
        acidic 
        content. 

I cells - Lipids and proteins signal cells to release ( Cholecystokinin )
    0  Function 
        1. stimulate 
           acinar 
           cells to 
           release 
           digestive 
           juices / 
          enzymes. 
       2. Stimulate 
           liver to 
           produce 
           and 
         gallbladder to secrete stored bile.

Question 8

Embryology of Pancreas ?

Answer 8

2 buds.

Ventral ( front ) pancreatic bud - attached to the biliary system i.e. common bile duct.

and Dorsal ( back ) pancreatic bud.

1. During development, the ventral bud rotates and moves posteriorly behind bringing the common bile duct with it.

2. Ventral fuses with dorsal. 
  0  Ventral 
       becomes 
       urnicate 
       process 
  0  Ventral 
       and dorsal 
       pancreatic 
       ducts will 
    anastomose 
     forming 
     main 
     pancreatic 
    duct and 
    accessory 
    duct.

Question 9

What is Annular Pancreas ?

Answer 9

Developmental anomaly - ring of tissue encircles duodenum.

CONSQUENCES
0 pancreatitis
0 Bowel obstruction

Question 10

Nervous supply of Pancreas ?

Answer 10

Parasympathetic - Vagus nerve
- increase secretion of digestive enzymes.

Sympathetic - Greater and lesser Splanchnic nerves.( Thoracic Splanchnic nerves - supply most of the abdominal contents - sympathetic supply ) - coeliac plexus and Superior mesenteric receive input from these.

Question 11

Referred pain -

Answer 11

0 Foregut pain - localises to epigastric area .

0 Midgut pain - localises to Periumbilical area - for example - appendicitis - pain felt in the periumbilical region.

0 Hindgut localises to suprapubic area.